The Golden Minute: MCHIP Promotes Helping Babies Breathe Program

April 28, 2011

By Charlene Reynolds

Bangladeshi mother, Minara Khan with her infant daughter Shira (left), who was resuscitated by a community health worker trained through Helping Babies Breathe.

Sixty seconds can mean the difference between life and death for a newborn who isn’t breathing. That’s the window of time a health provider has for resuscitation before a baby suffers injury from lack of oxygen. Jubaida Shirin knows how quickly that golden minute can tick by.

A community-based skilled birth attendant in Habiganj District of Bangladesh, Shirin got a call this past July from one of the women she routinely visited during pregnancy. Minara Khan was in labor. When Shirin arrived, she found Minara’s baby in the breech position. She quickly applied her training to deliver the child, but as she dried and wrapped the infant, she heard no cries.

The baby girl wasn’t breathing.

Shirin put the newborn on her left side on the mother’s abdomen, and tried with all of her might to stimulate the baby’s breathing by rubbing the skin over her backbone. But the tiny girl did not respond. Shirin next began resuscitating the child using a bag and mask as she had been trained to do through an initiative sponsored by the U.S. Agency for International Development (USAID) and promoted by its Maternal and Child Health Integrated Program (MCHIP), which Jhpiego leads, and its partner, Save the Children.

“We thought the child already died, but watched as Jubaida revived her, because of her training,” said a member of the new mother’s family.

Baby Shifa survived and is now a healthy three-month-old.

“MCHIP is proud to be an implementing partner in this commitment to provide lifesaving newborn care,” said Koki Agarwal, director of MCHIP. “Every child should have the opportunity to take their first breath and they deserve us being prepared to help them do so.”

An estimated four million newborns die annually during their first month of life. Half of these deaths occur during delivery and within the next 24 hours, often as a result of inadequate breathing or a failure to breathe. Every year, 10 million babies require help to breathe immediately after birth. Simple means to stimulate breathing, including drying and rubbing, and ventilation with a bag and mask, could save the majority of these babies who die. However, such care is available for fewer than one out of four newborns.

“When staff are recording still births, it may not actually always be a still birth,” said A. Udaya Thomas, a public health specialist with Jhpiego, who has observed high counts of still births and a lack of attention to the newborn post delivery. “It may be that the child was born needing assistance to breathe and was not revived. Timing is everything. You have that golden minute. If you take the right steps in that 60 seconds, you can prevent death and preserve life. A core group of Jhpiego international and regional trainers were trained recently at the Helping Babies Breathe (HBB) training in Washington, D.C., and we are already working on rolling out the training to other trainers, faculty and providers in the countries where we work.”

In Bangladesh, Jubaida Shirin got her resuscitation training through a successful pilot study conducted by Bangabandhu Sheikh Mujib Medical University Hospital, through MCHIP. The study included Habiganj District, where 212 community skilled birth attendants, including Jubaida, were first trained as part of the pilot. The results of this work so impressed the Bangladesh Minister of Health and Family Welfare, Dr. Ruhal Haque, that he pledged the government’s support in implementing a national scale-up of the HBB training program, beginning in October.

“I want to start work within the shortest possible time,” he said at a ceremony in Dhaka where Shirin came to receive her diploma and to share her experiences. “The government will take necessary steps to implement HBB in Bangladesh as soon as possible.”

A preliminary goal of the national scale-up plan will be to train close to 30,000 providers in newborn resuscitation. Eighty-five percent of births take place in homes in Bangladesh, but only 18 percent have a skilled birth attendant present. The remaining births are handled by untrained providers or family members.

Currently, there are 5,500 community-based skilled birth attendants in Bangladesh; the Health and Family Welfare Ministry plans to increase their ranks to 13,500, and provide them with six months of training to make them more effective in saving the lives of mothers and newborns.

Bangladesh was among a handful of countries (India, Kenya, Pakistan and Tanzania) in which HBB debuted with a curriculum specially designed for limited-resource settings. Sponsors of the program include the American Academy of Pediatrics, Save the Children, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, and Laerdal Medical. With MCHIP’s support, the plan is to introduce HBB in 15 countries in conjunction with governments, ministries of health and other partners.

Master trainers identified in each country will train birth attendants, who in turn will train others in the community. Just as Jubaida Shirin saved the life of baby girl Shifa, these newly trained birth attendants will possess the skills to help other babies breathe.